HomeMy WebLinkAbout0026 MEGAN ROAD - Health 26!-MeUan-Ro9d
Hyannis
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TOWN OF BARNSTABLE
LOCATION M ' Gv 1�0 SEWAGE# ®I "''3
VILLAGE I ,ASSESSOR'S MAP&PARCELS 01 '036
' INSTALLER'S N41E&PHONE NO. ,S_�c� ��••/�� \,�s aZ�I �f dV(��f
SEPTIC TANK CAPACITY �C ( 5 c^� �°j Pan D (U)c
LEACHING FAC i,ITY:(type) L Lc QAC,,164i�ize)
NO.OF BEDROOMS
OWNER . CQ MtaJ�
PERMIT DATE:j C> COMPLIANCE DATE: �b G 16
Separation Distance Between the: _
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility �� Feet
Private Water Supply Well and Leaching Facility(If any wells exist on
site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facility) Feet
FURNISHED BY
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No. t Fee `J
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes
01pplit Lion for MispoSAY *pstrm Coneit rtion Permit
Application for a Permit to Construct( ) Repair(,/ Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. {.�cq Gs 2� o��i Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel k`c, C"\)ri1\U
Installer's Name,Address,and Tel.No. J Designer's Name,Address,and Tel.No. S-p
Scw�\ kN3 0\4 'IC.re�®ll�h 5 � �c.G�S `'-0 QaX I(- S•n-tANO
Type of Building: S-OS apjL( Ob b
Dwelling No.of Bedrooms_�� Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) Z d gpd Design flow provided �17 gpd
Plan Date _( a.i ►�, Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S. L c 6 o r y,._N4
Description of Soil 'S ^ L �� 2 Q O (3 6-K
d Coc.rg-e SS u.,.d
Nature of Repairs or Alterations(Answer when applicable) jA_�-)/'�� l C LC c. c
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Signe Date I 0 /3 J/(
Application Approved by Date Z1 3 !�
Application Disapproved by Date
for the following reasons
Permit No._ /l,� '—� Date Issued (� 1�
f
Uf Fee
1 _ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: - !
PUBLIC HEALTH DIVISION'- TOWN OF BARNSTABLE, MASSACHUSETTS Yes
ftpUration for M sposar 6pstem Construction Permit
Application for a Permit to Construct( ) Repair(k/iUpgrade( ) Abandon( ,) ❑Complete System ❑Individual Components
Location Address or Lot No. o!Co MCC)D./, 2d pnhi, Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel � r'\1 r^ �9\ M oj\k\n r)
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. SO (.a g1-3�
5��� �rccnnk wz) U\4 YG.CMpiU4 5 vf_ NNc. 0 Q X I(o S 3 t)
`, S �' 6 D�n
Type of Building: WOK t( Ob b�
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
'I
Design Flow(min.required) `�`� (� gpd Design flow provided ci gpd j
Plan Date 01 1 , I Number of sheets Revision Date
Title
Size of Septic Tank e Type of S.A.S. t-C 6 ► q r t V.t aG Lhw�►b y
Description of Soil `.� n -t \-� a c� O Q G-K
(y1e coc rE-P, sc Nj
� I
Nature of Repairs or Alterations Answer when applicable) / L.e r_ c r r., s_crs j $kUn
i
i
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Signe . Date 13 J
i
Application Approved by Date /lj /3 J/
Application Disapproved by Date
for the following reasons
Permit No. 7 Date Issued
------------------------------------------------------ -------------------------------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage;Disposal system Constructed( ) Repaired(V) Upgraded( )
Abandoned( )by o M C -A-L(,
at G has been constructed in accordance
with the provisions of Title-
5 and the for Disposal System(Construction Permit No 901b dated /D J 3,// to
Installer S Cam Designer C,S
#bedrooms 3 Approved desi ow gpd
The issuance of is p rmit shall not be construed as a guarantee that the system wi funct, n ras designed.
Datef Inspector-----------------------------------------------------------'-------- -------------------------------------------------------------------
No. ��F3/to —3 '7� Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS
Misposal *pstem Construction Permit
Permission is hereby granted forr Construct( ) Repair( V Upgrade( ) Abandon( )
System located at b (y(y� { aid P yc,,t\n IT
I
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions.
Provided:Construction must be compl ted within three years of the date of this P
' rmit.
Date /.� �j Approvedy
Town of Barnstable
Regulatory Services
Richard V.Scali,Interim Director
Public Health Division
ems' Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Installer& Designer Certification Form
Date: Sewage Permit# -34.&essor's Map\Parcel
Designer: V1 RF_1y l�. }�,®►�S.��'° Installer: _544;F l•" i-'l• --e '
Address: 1' ' 0- 'kSo'X Address: (IS ®" � o�
On I3 \to Wit' • T=? K was issued a permit to install a
(date) (installer)
septic system at QLC (y►L C,,� (Z8 l����n� based on a design drawn by
(address)
(designer)
I certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank. Strip out (if required) was inspected and the soils
were found satisfactory.
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocation of any component -
a of the septic system) but in accordance with State & Local Regulations. Flan revision or-
certified as-built by designer to follow. Strip out(if required)was inspected and the soils
were found satisfactory.
I certify that the system referenced above was constructed "' nce with the terms
of the I1A approval letters(if applicable)
l
(Installer's Signature)
. J
(Designer's Signature) (Affix Designer's Stamp Here)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU.
Q:1Septic\Designer Certification Form Rev 8-14-13.doc
r -
Town of Barnstable Pit ( 5-
''� '� Department of Regulatory Services
wwarABLq Public Health Division Date
MAWL
200 Main Street,Hyannis MA 02601
. rfll Alltt A
Date Scheduled Time—�J Fee Pd._ ( 0 d
Soil Suitability Assessment for Sewage Disposal
Performed•By: Sl—t7P 14N-7 A f�- -rtS, P� Witnessed By: V1
LOCATION&.GENERAL INFORMATION
Loeadon Address '1 f Owner's Name W-,�N C)
a[lD n Xa"A n
ddrass
Assessor's Map/Parcel.•` r 2 _�3 Bngincer's Name
NEW CONSTRUCTION REPAIR i�z Telephone# �_b roa
Land Use `-- 7-7 142 Slo es 96
P ( ) Surface Stones �y
Distances from: Open Water Body ft Posslblc Wet Area ft Drinking Water Well tt
Dndhage Way tt Property Line Other $
SKETCH:(Street name,dimensions of lot,exact locations of test holes&pare tests,locato wetlands Itn proxim►ly to holes)
Parent material(geologic)�j'JT-Y'�RS L-I Depth to Bedrock
Depth to Oroundwater. Standing Water in Hole:_ $ � Weeping from Pit FACe
Bstimated Seasonal High Groundwater
D TERMINATION FOR SEASONALMIGH WATER TABLE
Method Used: .�45
n _
Depth Observed standing in obs.hole: / in, Depth to soll mottles) 7
pe th to weeping from side of qbs.hole: bi. Groundwater Adjustment I•
Index Well-# /W Reading Date: fv rti Index Well level `?� Adj4actor„ ,r Adj.croundwater•Level
PERCOLATION TEST D a I d '1<'ltna
Observation
Hole# Time at 9"
Depth of Pero L Y Time At 6"
Start Pro-soak Time 0 :c>L Time(9"•6"
End Pro-soak 5-1
Rate Mlh./Inch L 2
Site Suitability Assessment: Sito Passed d/ Site Palled: Additional Testing Needed(YIN)
Original: Public Health Division Observation Hole Data To Be Completed on Back-- - -
***If percolation test is to be conducted within 100' of wetland,you must first notify the.
Barnstable Conservation Division at least one (1)week prior to beginning.
Q:ISEPTICIPBRCFORM.DOC
DEEP-OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Shcl Color Soil• Other
Surface(in.) (USDA) (Munsell) Mottling (Structuro,Stonct.Boulders.
Consistency,%13ravall
DEEP OBSERVATION HOLE LOG Hole#
Dcpth from Soil Horizon,,-, Soil Texture Soil Color Soil Other
5urfaco(lo:) t t (USDA). (Munsell) Mottling' (Structuro,Stones,Boulders.
V,.
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil 'Other
Surface(In.) (USDA) (Munaeli) Mottling (Stricture,Stones,Boulders,
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Sot[Texture Soil Color soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders,
t
flood Insurance Rate Map:
Above 500 year f load boundary No— Yes _
Within 500 year boundary No Yes,;
u Yes
Within LN year flood boundary ry No.,� ...� .
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervious material exist in all areas observed thrpughout the
area proposed for the soil absorption system?
If not,what is the depth of naturally occurring pervious material?, ._.._.;...
Certification 9
I certify that on ! (date)I have passed the soil evaluator examination approved by the
Department of Environmental Protection and that the above analysis was performed by me consistent with .
the required tralningoxpertise and experience described in 4 10 CMR 15.017.
Datb 21 71�14
• Signature ,
Q;WHM0PHRCPORM.DOC
TOWN OF BARNSTABLE
Cn:LOCATION z �egCcn & / SEWAGE# Zlt�1a— t 9.
VILLAGE 91VI-4' n)S ASSESSOR'S MAP&PARCEL a 035
INSTALLER'S NAME&PHONE NO.�u4.pi000 f�icf',� [l� 92t-�z7I
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type)QO, ARG36 HG, Fl- (size) D"X 14.3�
NO.OF BEDROOMS .b ,
OWNER I� i ct m T) o
n
PERMIT DATE: (o'I J - 201'L COMPLIANCE DATE: 6
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 67, 03 6 Feet
Private Water Su pply Well and Leaching Facility(If any wells exist on
site or within 200 feet of leaching facility) ✓v Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within 4
300.feet o leaching facility) / Feet
FURNISHED BY i ��f�g (LL
A
A- 1 = 67
A -3 30:s`"
A.:r 1 o�6
A -,-r5a �8. �
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— =*5,7
TOWN OF BARNSTABLE
LOCATION 2ly M404 H /7�- SEWAGE #
"VILLAGE ASSESSOR'S MAP& LOT2
�� ,° f� 3� fit,INSTALLER'S(NAME&PHONE NO. s�
SEPTIC TANK CAPACITY '1000
�' + ;a LEACHING FACILITY:CII.ITY: (type) �Ott r. (size)
NO,OF BEDR i OMS :3
BUILDER OR OWNER IQc14 arj �YAA- (vw"'r)
PERMITDATE: COMPLIANCE DATE:
Separation DistaFnce Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility2 Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) *lk Feet
Furnished by fil Aa l k
" 4
P
9 �y
L
i (q
No. Fee
THP_ COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yew
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE,WASSACHUSETTS
application for Misposal *pstem Construction permit
Application for a Permit to Construct( ) Repair X Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. (� ( � �� 14 Owner's,N e Address,and Tel.No. i✓6LA
id DYLUMC1" 10b
Assessor's Map/Parcel (jar
Installer's Name,Address,and Tel.No. (S 0$--(4T?,8&1 j Designer's Name,Address,and Tel.No.
Ot&W tbS � 61E1 U,6 �C, �.
Type of Building:
Dwelling No.of Bedrooms Lot Size 11"4 sq.ft. Garbage Grinder( )
Other Type of Building ��i No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 330 gpd Design flow provided a3s�`,.. gpd
Plan Date j 5��(a. Number of sheets J Revision Date
Title a ,. kko—G IJ HY t )
Size of Septic Tank 1 ®0 o ^^Type of S.A.S. oy Cis
Description of Soil ( ► i;' QC**v
Nature of Repairs or Alterations(Answer when applicable) 4j3" (,&X_%- 1000 9:% 5171 M
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Signed Date (y "! —0)0
Application Approved by Date s
Application Disapproved by Date
for the following reasons
Permit No. r l Date Issued
No. 1 ( t+ .` Fee
THE-COMMONWEALTH OF MASSACHUSETTS , Entered inscomputer: /'
PUBLIC HEALTH DIVISION -TOWN OF,BARNSTABLE,`MASSACHUSETTS Yes
ltlYitatiDTC :fDr �I8p0846p8tP1II CollstCUttIOYC*Permit
I! Application for a Permit to Construct( ) Repair X Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
I` Location Address or Lot No.a(p (Ate; J IZt) 14 Owner' N e Ad a s and el. o.o D iAM.ti.!'r 1 Na
Assessor'sMap/Parcela
i
Installer's Name,Address,and Tel.No. d '��" 77 Designer's Name,Add ess and Tel.No,S sus—,Z3-0�1 7
6 5 S G 6C4t,t-XC Wk, St- we.45�(P 5�1 Ga7iidJ4 (fca�/
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 3 3 o gpd Design flow provided `sir gpd
Plan Date /6—6 s`a 0 Number of sheets_1 Revision Date
Title o �/tgGCyl.� �b K�/ l(/d✓�� y�
T Size of Septic Tank 11000 { Type of S.A.S. o�(� �E�Z�... 0 8�p �•s'��1
Description of Soil C-4 ti 56�
Nature of Repairs or Alterations(Answer when applicable) USE~ 15�C-CIKI-. 100(J
Date last inspected:
W
` $ Agreement: 3
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Signed / Date `(a
Application Approved by �(�( ."ys' Date V
Application Disapproved by Date
for the following reasons
Permit No. .2 o Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
(Certificate of (compliance
THIS IS TO C UUTI��F,,Y,that the On-site Sewage Disposal system Constructed( ) Repaired( �) Upgraded( )
Abandoned( )by '�Y'(i �� VW U�.rl:,
at �0(n ft�.`�toV RZ 1+'q"&X S has been constructed in acco ance
with the provisions of Title 5 and the for Disposal System Construction Permit No. } �tted
Installer G ��� GL� Designer _ ,(
#bedrooms Approved design flo 3� gpd
The issuance of thiQs',ermit shall not be construed as a guarantee that the system w 1 fii ti 11 as desig/4 d.
Date tp 0 r Inspector s'''/ 6
---------------------------------------------------------------------------------------------------------------------------------------
No. (� ' Fee U D c
THE COMMONWEALTH OF MASSACHUSETTS T
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
-Disposal *pstem Construction Permit
Permission is hereby granted to Construct( ) Repair(�) Upgrade( ) Abandon( )
System located at �� G`hUY �l�J GS
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions.
Provided:Cons ction t a completed within three years of the date of this permit. C
Date � Ti Approved by
Town of 0arnstablo
Regulatory Services
4 Thomas F. Geiler,Director
• Public Health Division
MAHB.
r6p `'i Thomas McKean,Director
200 Main Street, Hyannis,MA 02601
Office: 508-862.4644 Fax: 308-190-6304
Date: �O"�9'f'2 Sewage Permit# 2°1 2- - 1 I`t Assessor's Map/Parcel 29Z 2,36
Installer & Designer Certification Form
;c1enEe� ctse
Designer: SC I 'Toc, Installer:
Address: 2854 C canberrX Ikkwoy I Address: ° 3 G'- -7�"3
o s 1 �lJ 6 r G�ow► 1 A o Z S 3$ C�✓� �-cy.i e ✓✓�✓�
5o$-373"0377
On I z� IZ I w d i to install a
(� C�eM1�� � P�t1-> as issue a permit
(date) (installer)
septic system at 24, ldegan (Zo I,�► based on a design drawn by
(address)
S G '5 ,Tine_ dated Tune— 15, 2e 12
(designer)
1 certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as I4teral relocation of the
distribution box and/or septic tank. Stripout (if required) was inspected and the soils
were found satisfactory.
1. certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic system) but in accordance with State & Local Regulations, flan revision or
certified as-built by designer to follow. Stripout (if required) ected and the soils
were found satisfactory.
r CNHON L.
URCHILL �
(1n ler's Signaturo
a ♦164
esigner s Signature (Affix Deg Here)
P ASE RETURN TO ARNSTABLE PUBLIC REAL DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT B 1 ISSUED TIL ]ROTH THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BA.RNSTABL
THANK YOU. pUBX,IC HEALTH DIVISION
"
glnffice formsAuignercertification form.doc
i
Town,of Barnstable - P# 3
Departiment of Regulatory Services I
MUM M « Public Health Division Date
>�,
r fD 39.A�� 200 Main Street,Hyannis MA 02601
Date Scheduled i Time /
Fee Pd, 10 Q
NSoil Suitability Assessment for Sewage Disposal
Performed•By: , 1��'i��� S (•iY10d1k , 11�C$G-' Witnessed By: -
LOCATION&GENERAL INFORMATION
Locadon Address `;' Owner's Name NEILA J>I AHAi' T(NO.
.off(p fvl,�C—,>�.I�J RD N Ye4 rJ N t s
Address Rl> ti`yowols
Assessor's Map/Parcel: la/a- Engineer's Name (4pe-wta6: &.)T. L,I..0 4-TG Cv1�i�►PPti(Iq
NEW CONSTRUCTION REPAIR X Telephone# �6-0$" g77 "q?7-7. 508-273-6377
Land Use: SMAe, bMIJ y dU0,5 Slopes(%) Z-1 Surface Stones
Distance9 from: Open Water Body ft Possible Wet Area — ft Drinking Water Well ft
Drainage Way '" ft Property Line > l) ft Other _ ft
SKETCH:(Street name,.dimensions of lot,exact locations of test holes&perc tests,locate wetlands 1n pnoxiinity to holes)
6
S2� a-q" ,
Parent material(geologic) ooku.)AS�N Depth to Bedrock
Depth to Groundwater. standing Water in Hole: Weeping from Pit Face `
Estimated Seasonal H(gh Groundwater �O4 b9 5
DETERMINATION FOR SEASONAL HIGH WATER TABLE
Method Used: DlfftE 010sefLAait0A
Depth Observed standing in obs,hole: b in, Depth to Soil tnottleri
Depth to weeping from side of obs.hole: _ In, Groundwater Adjustment 1't.
Index Well# '- Reading Date: Index Well level -__ Adj,factor, Adj.droundwnterlevel,
PERCOLATION TEST bate &-8--12-1 - nme 10 r4 M
Observation _
Hole# ( Time at 9"
a
Depth of Perc 2 y c12 J` Time at 6" _
Start Pre-soak Time @ L 0'1 y A M rime(9"-6") _
End Pre-soak I O i Zy AH
Rate Min:/Inch 2. I
Site Suitability Assessment: Site Passed l e S Site.Failed: — Additional Testing Needed(Y/N) /V
Original: Public Health Division Observation Hole Data To Be Completed on Back-------
***If percolation test is to be conducted within 100' of wetland,you must first notify the !
Barnstable Conservation Division at least one(1) week prior to beginning.
Q:�SEPTICIPERCFORM.DOC
-� DEEP.OBSERVATION BOLE LOG Hole# I k Z
> Depth from Soil Horizon Soil Texture .Sdil Color Soil• Other
Surface(in.) (USDA) (Munsell) Mottling
(Structure,Stoned;Boulders.
��R6't3rave1l
Joy(3/1
y-2y 6 -
2y'�Z GS
s-lo"/� StYitJc,�
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) a (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency.
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
C sistency,%a
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon 'Soil Texture Soil Color soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones',Boulders,
C
y
Flood Insurance Rate Map:
Above 500 year flood•boundary No—. Yes .
Within 500 year boundary No Yes '
Within WO year flood boundary No.—
Yes
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the
area proposed for the soil absorption system?
If not,what is the depth of naturally occurring pervious material?
Certification
I certify that on l U"27'9 9 (date)I have passed the soil evaluator,examination approved by the
Department of Environmental Protection and that the above analysis was performed by me consistent with .
the required training,expertise ayd ex I nce described in 10 CMR 15.017.
Signature Datb
4
Q:\S,EPTIC\PERCPORM.DOC
t
4Y rt2 P 0 '
i COMMONtiVEALTH OF MASSACHUSETTS "T
• �; Rr . AIRS •, r� •�,EXECUTNE,OFFICE OF Ei�I ON +Tr1'F1�8�'F
DEPARTMENT OF`ENVITITOTECTION
ti
_ ?' ` t�-ae't''- ,�5,`tr�� f c ' R., `}•e�b 3p.,: S.a:`:.
V
'
• - TITLE 5 ,�.� .- �:�: . ; ..
OFFICIAL INSPECTION FORM—.NOT FOR:YOLUNTARY,ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL• SYSTEM FORM
PARTe A
CERTIFICATION
Property Address:
Owner's Name: e h
Owner's Address: 16'Mega Rd ,M a _
Date of Inspection: 16—0 S' 1 /� NafL
' -• •/� /! /I�
Name of Inspector: (please print) TO „
Company Name �oL+.-1 n v vim' {-v�
-
Mailing Address / 2 a H ri 5 71
Telephone Number: S�8—`128- 7779
' CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that.the information reported
below is true,.accurate and.complete as of the time.;of.the inspection,,The inspection;was.performed based on my
training and.werience•in the proper function and maintenance osf on site sewage_disposal systems.I am a DEP
approved system inspector pursuant to Section.15.340 of Tiik; (310 CMR{15 000).;,The,system:.
..E. 16 .. �°�h•,.i;». .:);.,�y� .: .., . },. `ti��'r ays rS�'�::"$4 i."t F�"' i.,hf .a i F-',: ..i- '. •i. :
l/ Pass,es
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
Fails
Inspectors Signature: ag��
The system inspector shall submit a copy of this inspection report to the:Approving Authority(Board of Health or
DEP)-within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000
gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the
DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving
authority.
Notes and',Comments'
****This report only describes conditions at the time of inspection and under the conditions of use at that
time.This inspection does not address how the system will perform in the future under the same or different
conditions of use.
i
Title 5 Inspection Form 6/15/2000 page 1
a 1
,
Page 2 of 11
OFFICIAL;INSPEC-TIONAFORM=NC)ttbii`VOI'UNTARY ASSESSMF..N- -S
SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: R
Owner:,
s /I
Date of Inspection: G'-0 :
Inspection Summary � Check'A,B,C,D or E/ALWAYS complete'aH oiSiltlom D
A. System Passes:
V I have not found any,information which indicates.that any of the failure criteria described in 310 CMR
15.303'6r in 310.CMR 15.304 exist.Any failure criteria not evaluated are indicated below.
Comments:
B. System Conditionally Passes:
F
One or more system components as described in the"Conditional Pass"•section need to be replaced or
repaired.The system,upon completion of the replacement or repair,,as approved by the Board of Health,will pass.
Answer,yes,no or not determined-(Y,N,ND)in the for the following.statements."If"not determined"please
explain.: "V
'"a•'The septictank"is metal and over20 years bld*'or the'septic tank(whether metal or not)is structurally
unsound,exhibits substantial"infiltration'or exfiltration,or tank faihire is imminent System will pass inspection if the
existing tank is replaced with a'complying septic tank as approved by the Board of Health ,'''"$ +
*A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance.
indicating that the tank is less than 20 years old is available. ' J4
ND explain: .l-- 4'
Observation of sewage_backup or bret
out or high static water level in the,distribution box due to broken or
obstructed pipes)or due to a,broken.IUttleduneven distnburion box.,System will pass mspwion if(with
approval of Board of Health):
.,broken pipes)
fIs, obstruction is removed.
distribution box is'leveled or.replaced
ND explain:
The system required pumping more that d 4 times a year duets broken or obstructed pipe(s).The system will
pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced:.
obstruction is removed
e'di; yip.
ND explain:
2 s
r
• Page 3 of 11
OFFICIAL"INSPECTION FORM`-NOT`FOR-VOLUNTARY=ASSESSMENTS
l SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM
PART X k
CERTIFICATION-(continued)
Property Address: 10Q. Rd
Owner: L
Date of Inspection: y-- (, 0
C. Further Evaluation is Required by the Board of Health:
Conditions exist which require further evaluation.by the.Board:of Health in.order to determine if the system .
is failing to protect public health,safety or the environment.
1. System-will pass.unless Board of Health determines in accordance with 310 CMR 15.303(1)(b).that the
system is not functioning in,a manner which will protect public health;safety and the environment:.
,r Cesspool or privy is within 50 feet of.a surface,water,� ,v'`
_ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
.. f' f`.« JCi. t i x ;R .t -•-ir 'tt .. R..3 .P t. , > c !'if ... .. ..m.. _ .-
.. W s'�'+ F a♦ ♦ . h � !'pro #•e -P rt yl'� - .�na >e �r:s .. ..
2...: System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the
system is functioning in a manner that protects the public health,safety and environment:.
i'.A:The system has a septic tank and soil absorption system(SAS)and the SAS is within:100 feet of a
u surface water-supply or tributary to a surface.water sup ply.". 7
..:The system has.a septic tank and SAS and the SAS:iswithin a Zone 1 of.a.public water supply..
t 3- 9g
s :;. r. ..��' Y• „'.,:'t";.xiti_oa xl pY i+#::isa
The system has a septic.tank and. SAS and the SAS is,within'50 feet of a private water supply well.
-The system has a septic tank and-SAS and the,SAS is less than 1.00 feet but SO feet or more from a
private.water.supply well*.*.,Method.used'to determine distance
, cv SA�•'..+.�fikn u.,..Y.4 34' ... . lit . C, . . lii
"This system passes if the well.water analysis,performed at a DEP certified laboratory,for coliform.
bacteria and volatile organic compounds indicates that the-well is free from pollution from that facility and
the presence of ammonia nitrogen and'nitrate nitrogen is equal to or less than 5 ppm,provided.that no other
failure criteria are.triggered A copy of the,analysis must be attached to this form.,:::
3: Otber•
-
r ;:> .S`i.%
3
•
Page 4 of 11.
OFFICIAI�INSPECTION.`F.ORM,=NOT�: OR VOLUNTARY:ASSESSMENTS
"SUBSURFACKSEWAGE DISPOSAL'SYSTEM:INSPECTIONJFORN,,`
PART,A 3
CERTIFICATO 4(continued)".,
Property Address: /N H. R�
,S
Owner: .91Ja)-j 4 c Aw• : . .
Date of Inspection:- 41 Z6_p ,.
D. System Failure Criteria applicable to all systems:. .,�,',
You must indicate"yes"'or."no",to each of the following for all inspectioA ,� !1,'r
Yes - No
'Backup of.sewage into facility or system component due to overloaded or clogged SAS or cesspool
✓;Discharge or.ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool
A--- Static liquid level in the distribution box above outlet invert due;to an overloaded or clogged SAS or
cesspool ii
.:Liquid depth incesspool is less than 6"fbelow invert or available volume is less than''/:day flow
_ ✓ Required pumping more than 4 times;in the last year NOT due to clogged or obstructed pipe(s).Number
of times pumped
Any portion of the SAS,cesspool or privy is below high ground water elevation.
Any portion of cesspool or privy is within 100 feet.of a surface water supply or tributary to a surface
,-4 ':water supply.`
_�f Any portion of.a_cesspool or privy.is within a'Zone l:of a public well..,.:.• "
_t::f Any portion of a cesspool or privy is within 50 feet of.a private water supply well.
✓..,Any.portion of.a cesspool or.privy is less than,100 feet but greater.than 501eeffrorawprivate water
supply well with no acceptable water quality analysis.,[This system passes if thew water analysis,
performed at a DEP certified laboratory,for.coliform bacteria and volati elle organic compounds
indicates:thaf the-well is free from pollutioaarom:that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other fallim criteria
are triggered.�A copy.of the.analysis must be attached to this form.l ""n%,
/VD (Yes/No)•The system fails.I have determined that one or more of the above failure criteria exist as
described in 310 CMR 15.303,therefore the system fails:.The system owner should contact the Board of
Health to determine what will be necessary tocotrect the failure.
• t`:a ,t.3�a s.11 °`r,..,t;, a 7..: .:+z "'"Y"w .et ".�•: ' ... ... .
it« 44
E. Large Systems.
To be considered a large system the system must serve a facility with a design flow of.1,0,000 gpd to 15,000
gpd.
You must indicate either"yes"or"no"to each of the following:
(The following criteria,apply to large systems in addition to the miiixia above)
yes no
_ __the system is within•400 feet of a surface drinking water supply _ „` .• ti u ..
the system is within 200 feet of a tributary to a surface drinking water supply y
the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—I WPA)or a mapped
Zone 1I of a public water supply well
If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered
"yes"in Section D above the large.system has failed.The owner or operator of any large system considered a
significant threat•under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR
15.304.The system owner should contact the appropriate regional office of the Department.
4 J
Page 5 of 11
OFFICIAL'INSPECTION F}ORM=NOT FOR'VOLUNTARY`ASSESSMENTS
'SUBSURFACESEWAGE°DISPOSAL4 SYSTEM'INSPECTION FORM
PART•B
c CHECKLIST
}
Property Address: 26 ylQ u �
- Owner: it c 14 -
Date of Inspection:
.4
Check if the following have been done.You,•must indicate`des"or'"no' as to each of the following:
Yes No d ,
Pumping information was povid i d by'the owner,occupant,`or Board of Health
_ ✓ Were any of the system components pumped=out in the previous two weeks?
Has the ,
system received normal flows'o s>n the previous two week period . `
Y P P
_✓Have large volumes of water been introduced to the system recently or as.part of this inspection?
Were`as built plans of the system obtained and examined?(If they were not available note as N/A)
_f Was the facility or dwelling inspected for signs of sewage back up?'
v Was the site inspectedfor signs of break out? f
_✓_ Were all system components,excluding the SAS,located on site?
_ Were.the septic tank manholes unJovered,opened,and the interior of the tank inspected for the condition
of the baffles or tees,material of construction,dimensions,depth of liquid,depth.of sludge and depth of scum?
Was the facility,owner(and occupants if different from owner)provided with information on the proper
maintenance of subsurface sewage disposal systems
<4-r
The size and location of the So11 Absorption System'(SAS)on the site has been determined based on:
Yes no
jZ'_ Existing information.For example,a plan at the Board'of Health.-;
Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance
is unacceptable)[310 CMR 15.302(3)(b)J
� n fa - j ,fin Yy 7:ti
. I� 5 •
Page 6 of I 1
. OFFICIAL INSPEGTIONFFORM NOT FOR QLUNTOY ASSESSMEN3S .
w -SUBSURFACE SEWAGE DISPOSAL:SYSTEM INSPECTION FORM
_•Ye „a .., ... .. : � . � ,b lY
PART.0
SYSTEM INFORMATION
Property Address: 26Mleelaof R
-c nnlS /f1 .. 4.. .
Owner:
/ ♦ 15
Date of Inspection
-
FLOW CONDITIONS .. •..
RESIDENTIAL'
Number of bedrooms(design):.' (Number of bedroomss(actual): 3 �.
DESIGN'flow,bas. on 310 CMRz15 203(for example: 110�gpd x#of bedrooms)
Number of current residents: V.
Does residence have a garbage grinder(yes or no)
Is laundry on'a separate sewagesystem(yes or no) :[nf yes separate,inspection required]
Laundry system inspected`(yes or no). i ,
Seasonal use:(yes or no):yrzj
,. �a�l
Water meter readings,if aCv;ilable(last 2 years usage(gpd)) y 7 6 4 rr c1a y y y
Sump Pump(yes or no): Nv 4
Last date'of occupancy 1 100
COMMERCIAL/INDUSTRIAL
Type of establishment:. e
Design flow(based on'310 CMR 15.203): r pd'
Basis of design flow(seats/persons/sgft,etc).
Grease trap Ipresent(yes or no):
Industrial waste holding tank present(yes or no):
Non-sanitary waste-discharged to the Title 5 system(yes'or no);
Water meter readings,if available: r. ,
Last.date of occupancy/use:
OTHER(describe) ,t
:, Y # GENERAL INF ORMATION .., , r
Pumping Records } . , .... r
Source of information: 2,wm R«o dej f u rM i- /- 4'
Was system pumped as part of the inspection(yes or no 0
If yes,volume pumped:__gallons'--How,was quantity pumped determined? .
,.Reason for pumping
TYPE OF SYSTEM
✓Septic tank;disWbudon-bax,soil absorption gsieza
Single cesspool.
Overflow cesspool . M
Pri`T' ,
Shared system(yes or no)(if yes,attach previous'inspection records,of any)
Innovative/AltematiVe technology.Attn ka cgpy of the cunt operation.and maintenance contract(to be
obtained from system owner)' ,
_Tight tank Attach,a copy of the DEP approval
Other(describe):
Approximate age of all components;date m , lied(if known)and source of information:
Were sewage odors detected when arriving at the site(yes or no):_No
Page 7 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
:' ;. •` SUBSURFACE�SEWAGE'DISPOSAL:.SYSTEM INSPECTION FORM
g f 3 PARTC '
t SYSTEM INFORMATION(continued)
Property Address: J61 lot, R
Owner: e,krj
N c
Date of Inspection: �L St G—oS'
BUILDING SEWER(locate on site plan)
Jt
Depth below grade:'
Materials of construction:_cast iron 40 PVC other(explain):
Distance from.private water supply well or,suc ion.-line:
Comments(on condition of joints,venting,evidence of leakage,etc.)r
SEPTIC TANK:_(locate on site plan)
Depth below grade: 6„
Material of construction: �oncrete_metal fiberglass:=polyethylene -,} ;
_other ex lain
g
_ If tank is metal list a e: Is age confirmed by a Certificate of,Compliance(yes or:no): (attach a copy of'-
. . p
certificate).. /
Dimensions: X 6�
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle 26,
Scum thickness:• , � ,, ,, � °..�. ,�, ::,.. .,��►.� ,{T Y # -
-Distance from top of scum to,top of outlet tee:or baffle
Distance from bottom of scum to bottom of outlet,tee or baffle:
How were.dimensions determined; A4�,su},s 1.-4 . '
Comments(on pumping recommendations,inle and outlet tee or baffle condition,structural integrity,_liquid levels .
as related to outlet invert,evidence of.leakage,etc.):
s'ys t L4>4 ! y.try 5A04 1 ti q �,� :�N �- I -few y esr r 5
GREASE TRAP:_(locate on site plan):
Depth below grade;_
Material of construction . concrete , metal fiberglass polyethylene_other r
. (explain): . .— .. • ,.— .
Dimensions: "
Scum thickness t .
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to'bottom of outlet tee.or baffle:
Date of last pumping:
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evidence of leakage,etc.);
.. . 7 i
Page 8 of 11"j
r '
'f4 `r .:� 19 ��•'6w. �3sT�• 4,,, � :f �as o f �Y•. ' i �i� ._ ,E 1ay•,k'f. •@•3`y;,c` ,
u,OFF•ICIAL%INSPECTION.FORM, . NO ': ?(? -,VOL
UNTARY ASSESSMENTS
s SUBSURFACE SEWAGE DISPQ•SDAI::SYSTEM:IN CTYON"FOR1N:
;:.SYSTEM INFORNtATION`(continued) ,
Property Address: :94' /0 eall.,N
S IWIF
-
Owner: r q ti
Date of Inspection:
`TIGHT or HOLDING TANK (tank must pumped at time of iitmpert3onatean site plan)
Depth below grade:
Material of construction concrete - metal., fiberglass polyethylene., other(explain):
Dimensions: r: ru
Capacity: ` gallons
Design Flow: gallons/day
Alarm'present(yes or no);
'Alarm level; Alarm in.working.order(yes or no).
Date of last pumping:
Comments(condition of alarm and float switches;etc.)
.•
P.
DISTRIBUTION BOX: (if present must be opened)(locate on site plan)
5 s'
Depth of liquid level above outlet invert
Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of
' leakage into or out of box,etc.):
it t
A•i i .1.k f ♦. •� ,r• 4 f.�.4y,. j
PUMP CHAMBER-. (locate on site plan)
Pumps m working order(yes or no)
Alarms in working order(yes or no): " Y.,:.. " ? ;° '' :_ •> •r
Comments(note condition of pump chamber,conditicat of'pmttps,and appurtenances;etc.x
4..
j
rr.,d.k.'d74 4,r,a,i.�:.r' •r ,.-;y S .+5„, •rn ,Ja .r# , 1 's 4..r a p. t.� j. - Y y - ..,
�.'• P.i:;1w.+ .,r.,,:.. i9 '+'S ..,,.i•+WVY.^ti'.1 ,^i. y.� Yr�... ., ., . .... ... , 'ta e. . •
-
Page 9 of 11
OFFICIAL INSPEION FORM ; NOT FOR YOI;UNTARY=ASSESSMENTS
BUBSURFAC :SEWAGE.;DISPOSAL:SYSTEM•INSPECTION�FORM
PART C:
" SYSTEM..INFORMATION`(continued)
Property Address: 6 4/loyti✓! ��
17WAAHi S
Owner:
Date of Inspection
SOIL ABSORPTION SYSTEM(SAS):. ... (locate on site plan,excavation not required)
If SAS not located e�cplainwhY.:; .,.._ .. 1 4. �. _ ...
• 'vim ! i r'
TYPe k
✓leaching pits,number:'
leaching chambers,number.
leaching galleries,number.
leaching trenches,number,length: `
leaching fields,number,dimensions:
overflow cesspool,number:
innovadve/altemative system Type/name of technology: '
._Comments note condition of so
il,.si.gam.of h draulic failure level of P
onding,damP soil,condition o vegetation,
n,
etc.): ) //
r. T
CESSPOOLS: (cesspool must be pumped as part of tnspection)(locate on site plan) =
Number and configuration:
Depth-"top of liquid to inlet invert:
7 Depth of solids layer.. '
Depth of scum layer:
Dimensions of cesspool;
Materials'of construction:
Indication of groundwater inflow(yes or no)
Comments(note.condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
PRIVY:' (locate on site plan)'
v: s
Matenals.of construction.
.r .; ,
°,:Dimensions:
Depth of solids. .
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation;etc.):
g {
.. � •, frq xM..4Y .t•. tart�, ._fi s„ k:Y .
Page 10 of 1 l" .�
OFFICIAL INSPECTION.FORM.'-R0tt--FOA;VOLVNTXAY•ASSESSMENT-S
�,wSUBSURFACE-SEWAGE DISPOSA"i;`SMEM INSPECTION FORM "
rs,• SYSTEM INFORMATION(continued)'.' ;
... _ ,r Via.. s •-�, .. a•'} . . �J,.,• lw .e y,; � ..� •t r ...
.f.
Property Address:
.. qH
Owner:
t 'l 5
Dat
e of
InsP e ction - _
In .
ti d c�
•.c
avrLl.i/TCH OF SEWAGE DISPOSAL.SYSTEM .•,_
-:Provida'a ikeW4 of iho.sewage disposal system inclgding'tiesJto at least two permanent reference landmarks or
;. beachmaiks Locate all.wells within 100 feet.Locate where pubLc watersupply eaters.the building. .
�• �'. 20 T:'. � 4f� .,- �'� , {• � � ..
'310
6ti •° l
k
�" � , } `+0 1t3 � l z t... &\���� li' l rll:,� + ,;J •,�.:c'a ���i . t.°4.. .. .
t ( Y !
r 1 r g k i (a v
y . ; r-Zt. J•{ �:- SSo-�U�.:I.r l" of„r ?I..,d�}'., ; '1(V�' .l-.h�.�.,q l a �(r t•:.': �• ,.,
F. ,(1 '� ,i •♦��,�fYl •i l•t�„y ir; i1 V'1+:��}yf Zv.uF4 A„f.Jt :0: t, Yfd�'ti t. �. .,a l..f ..r L 52:,• l .l
4
f a '+.,w•+« Lu r <:^�'t +�1 a iw,.{n,. ^ ._ .. .... ...
p
9 i 49
M
l
, l
" . 10#
Y . } ',_ - I.
Page 1 1 of l I R
OFFICIAL'`INSPECTION FORM :'NOT FOR VOLUNTARY ASSESSMENTS
S.UBS�URFA I S WAGE DISPOSAL SYSTEM INSPECTION FORM.
.�... .:,• . } PART,C f .
j t SYSTEM INFORMATION-(co tinuedy .
Property Address. c `� /4a , ' , , .
L1Ny,' M
Owner' ' ��.u r E . _
Date of Inspection y 26=0 5 t
t
=SITE EXAM sn '
Slo >x t .,r
>! S water i :
Check cellar' .
"" RShallow.wells' r 1=
T .; �.4 0 -
Estimated depth to ground water 1., 7 feet ..,.MM*M-�.:M.�.,I.M,.�I
a �. . .
�_
w
. .
Please indicate(check)all methods used to determine the high ground water elevation
I. .
r
•
Obtained from system design plans on ecord If checked,date,of design plan reviewed -'
r ` i'Observed site(abutting property/observation hole within 150.feet of SAS)
Checked with'local Board of Health-explain "
1 <
Checked.with local excavators,installers (attach documentation)
t/Accessed U G data S S base-explain ` d _;
. .
r You must descnbe how you established the hi h gr/oiihd water elevation.'- -
. 1 `,
N / " N0*1 Wail h :.A t ;
.40 ei» .14�+
z ` �.0 ` t
"i- !s • q,
,; L L F J a, het. ,s
A. ' # t
dVa !d h
# ;. ,S:f 1Y i.r� �,1 } ti s `
l 4' ..
p
' -1 .5 ! •
�' } 1 ; 4F M 1 4,4
t y i
Y r f< . y n# k
.. ! i f - ..
,1'. Y S y 1 tl' S r 1 Y
x vq c �y 3 1 8;
a; Iq 4dr is a 1X-
t sty '2 e[t t t 7 . r q r, Y " r
'x AL 1_ to e - 1 •, 2 + a
s
-' t r .a.` .i. M - .
<` '
;,
,. .
' t _ ._ .
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5 a
! 11
/Y _ t • ..
ASSESSOR'S j MAP NO. a u a. PARCEL
LtyCATION' SEWAGE PERMIT 0.
c;26 m 6Aal RL�
VILLAGE
INSTA LLER'S NAME A ADDRESS
StuP, 61 sl :ST
37A
R U I L 0 E R OR OWNER t'
C:
I
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED
i
-------------
R�
7l, f
0
_ w
e �
i
1
`IJo......... -3: 1. Fss.... . .................
THE COMMONWEALTH OF MASSACHUSETT-S
BOAR® OF HEALTH 9,L 36
- OF......................................................................................
Applira#ion for Disposal Works Tonstrnrtinn Vrrmit
Application is hereby made for a Permit to Construct ( ) or Repair { ) an Individual Sewage Disposal
System at• OY A'V
....... .�_ 0-----------•------•-------------------- ---------------------------------.. •-----•-----------------•-----------------------
'%�r�ocation_Addresg
.. or Lot No.
........... ... ......................................
p r Address
a ......................... ...... . ------------------------------------------ ------•-------------•--••-•---•-------------............•--------------------•-•...
Installer Address
Type of Building Size Lot_1.4.4.1.9 Sq. feet
Dwelling—No. of Bedrooms.___.._._Z.............................Expansion Attic (,,vo Garbage Grinder (V)O
p`4 Other—Type of Building ____v o A_—.. No. of persons.............7------------- Showers ( e) — Cafeteria
dOther fixtures ------------------------------ ��
W Design Flow...............................u�_:..6.._gallons per person pe day. Total daily
flow............................................gallons.
WSeptic Tank—Liquid capacity�B_U®gallons Length____.__:.... Width. Diameter______ Depth.._..-_--___.
x Disposal Trench—N -------- ---------- Width__._._.�._____._ Total Length.. Total leaching area_�.�_-.., g. . ft.
Seepage Pit No___________________ Diameter.._.. _1.�.. Depth below inlet _ . Total leaching area."?__C_'�ASCP ft.
Other Distribution box Dosing 81n1k
Z Percolation Test Results Performed by....... 1'2,•Gl •-• -C.B .................. Date.... -a.s_�_7. '
`�a Test Pit No. 1................minutes per inch Depth of Test Pit-------- ----------- Depth to ground water....
/..... __.
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
Pd V
--- _.. .. r............. .Description o Soil (,�`._ _..... ` ...........
. --'--------•--•-------•---------•-------------
x
--•------•-----------------------•-----------------------•------•---------------------------------------------•---------...----•------------•••••---------------•-•--------------------•-------.......--
U Nature of Repairs or Alterations—Answer when applicable.___............................:..............................................................
----------------•-------------------------------•-•--•------------......_----------.....---•-----------•-•-•----------------------------------------------------•---------------------------------•----
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TIT?.:. 5 of the State Sanitary Code—The undersigned fuyrther agrees not to place the system in
operation until a Certificate of Compliance has been
Jissu y the board of h th.
Signed//!N .............. 7�> ....
- - -----
Date ,
Application Approved By......... � •---_-------------- ���'�� .......
Date
Application Disapproved for the following reasons-------------------•--------.....---------------------------------------------------------- -----•---••-•--•••.
••----•-•-•----------------------------------------------------••----------------------••-•--------••--------•-----------------------------------•._..........----•-•--•-----•-------------------•-•-•-
�� �� Date
PermitNo......................................................... Issued... --•---..--...----------•----
Date
THE COMMONWEALTH OF MASSACHUSETTS
rt BOAR® OF HEALTH
........................:...................OF..........................._..-._.....--.----.-•----...........---........---...--.......
,�t��lirtt�itttt �n�•���$�t���u�tt1 3��xk� C��tt��rttr�ilatt rrmi�
Appl„ication is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
..... .: .. - -_._ ...... ................................................
...... •---------
ocation-Address/,�' or Lot No.
W �� Address d���• ---
Sri ------------------------------------------- -----------
Installer Address
Q Type of Building Size Lot.. -:--------. --Sq. feet
Dwelling—No. of Bedrooms ..........................Expansion Attic (409 Garbage Grinder
Other—Type of Building ..._ " _ ... No. of persons...........1rt........... Showers ( ) — Cafeteria ( 't
Otherfixtures ---------------------------•--------.•--•--••••---•-•---••••--------------••---.... •.... ------
W Design Flow...... "`' -.-$! .gallons per person p*day. Total aily flow...........- . . ................gallons.
WSeptic Tank—Liquid capacity;4 a U9-gallons Length....... ..... .Width.. ___. Diameter___-_: ....... Depth....SIX----
x Disposal Trench—N . ....... ............Widt _... (-........ Total Length�i�' Total leaching area Z . ft.
Seepage Pit:No_________ ____ Diameter.___. ,'Z..'Depth below inletf.�" Total leaching area_ .r.. r._sc ft.
Z Other Distribution box O osing tank
~' Percolation Test Results Performed by......` q•{�.�___. �.......~.......... Date_.. ,r-2.�tr`'.�.'_t�'''•...
1.4 Test;,',,t No. I................minutes.per inch Depth of Test Pit___._.._ __.._._... Depth to ground water.___//
_-
(s, Test Pit;-No. 2................minutes per inch Depth :of..Test Pit........::._.__.--- Depth to ground water........................
t� i ••-----•--=----- ..
iF
Description of Soil..--•.-_40'.•-0---....... =°,� " ` ----•---- -•-•-•-•-------••-•--•----
x - _ _ ;
W -••-----------------------•------------------------•- ------------------------------------------------ -- --------------- ---------•---------------------------- ...--------...---•--
U Nature of Repairs or Alterations—Answer when applicable............................
--------------_____ __..........................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of iIT� :
p 5 of the State Sanitary Code— The undersigned flrtl er agrees not to place the system",in
operation until a Certificate of Complianpolhas been issu y the board.of h 'lth
Sign
D ate
1 Application Approved By... . ..•-••-•---
�, k Date
Application Disapproved for the following reasons:. ......... ....... ......_._ ...... ------------......__.._....._....._. •...::.....J -----
.......1................................................................................. ........._ _....... .. .. �.• ............
+ .. ._ ...........--_.._ � � spat
Fermat No......................................................... Issued---- . -- ..................................
'
y Date
THE COMMONWEALTH OF MASSACHUSETTS Y
BOARD O HEALTH
...........OF......... 1...................
�rr#g��rtt#r ,af f�nr�tt�litttt�.�
THI IS CE , FY, That the Individual Sewage Disposal System constructed ( or Repaired ( )
by.. ---------------------------------------------------------------------------------------••--•----Ode
"----••--•----•--..__...----------
• I taller
a /
-------------------
at.........ben installed in accordance with the provisions of r of Th State Sanitary Cs described in the
application for Disposal Works Construction Permit N .__ �_....___----•-•. dated--,�:_../f�.. ................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE.CONS gUED ASA GU RANTEE THAT-.THE
SYSTEM! WILL FUN TI N SATISFACTORY..
DATE �, �
...................
:'
,��� nspectgr'� �...
THE COMMONWEALTH OF MASSACHUSETTS
A , BOARD O HEALTH
7&
FEE...............
Disposal k W Str itttt rrnttt �.
Per ission is ereby granted..------ '�'i� ------•---------•--------------------------- -- .......:.........•.
to Con uctf( ) or Repa' ( , an Individ Se ,age Disp4te�;t
tem
at No //..�'�'�� 7
as shown on the application for Disposal Work Construction'.Per No ,.:..___..... Dated.],/__.O!!W..-:........
Board of Heal
DATE. % y-----...................... ---..... "m
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS ter..
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THOMAS E.KELLEY CO.
ENGINEERS—SURVEYORS
346 LONG POND DRIVE
SOUTH YARMOUTH,MAS&
oz664
N DFMgssA�,
TH MAS- THOMAS �G
KE LEY � v KEUEY H
o,A Zm 24260
+FOf8TE q 9o�FG/STEP`
t ���suo FNAL Eab ai .
CERTIFIED PLOT PLAN
LOCATI,,0N �WIU KT 4F. k�.I` )4,..
SCALE . .('
c X�. . . DATE . . . 7a .
PLAN REFERENCE�\yY
I CERTI THAT THE ... ...... . ...... ....... ........
SHOWN ON THIS PLAN IS LOCATED ON THE GROUND
AS SHOWN HEREON AND THAT IT CONFORMS TO THE
SETBACK REQUIREMENTS OF THE TOWN OF
WHEN CONSTRUCTED.
DATE ��.ZJf��.. . .
PETITIONER: /��r��ron�S � ILDS /�� REGISTERED LAND SURVEYOR
i S�fEE T 2 oe 0
TOP OF FOUNDATION
` CONCRETE COVER
CONCRETE COVERS
,;o "4„CAST IRON 12"MAX. 12"MAX.
• PIPE (OR 4"ORANGEBURG(OR EQUIV.)
)- MIN. PIPE- MIN. LEACH
PITCH I/4"PER. PITCH 1/4 PER.FT PIT
PRECAST
o'� INVEES�TT - • °. a 'r..::
LEACHING
` o EL.jfJ!9�.. SEPTIC TANK INVE DIST.'• INVE T �'� PIEQ�
� V. ,
,.o INVERT QDD BOX �:
�. . . .. .. GAL. INVE�� _ IL Q'
ELI<... INVER I`c� ww fie: :►: 3/4"T0Ii/2
� EL44! . ;• L` WASHED
c ° w / � � :• w :.'.' STONE
PROFILE OF cRouND WATER TABLE
SEWAGE DISPOSAL SYSTEM
NO SCALE
SOIL LOG WITNESSED BY :
DATE .SZ�.�c�. TIME.�Or �./?�,/ / �l/Gu. . ./ / T BOARD OF HEALTH
TEST jHp L 1 TEST HOLE 2ENGINEER
ELEV
77
DESIGN DATA ' :
NUMBER OF BEDROOMS Tea
ow
TOTAL ESTIMATED FLOW _ . Z2rQ. . . GALLONS/DAY
BOTTOM LEACH I NG AREA ��3�I�. - SQ.FT. /PIT
SIDE LEACHING AREA . .�.rD�B� . . SQ.FT/ PIT
T GARBAGE DISPOSAL . . Dom./(50% AREA INCREASE)
t1Z4,"(35oc�) TOTAL LEACHING AREA . /-94). SO.FT
ATOLT 13LL,- PERCOLATION RATE . . . . TwO. _ . .-. MINq/INCH
``// LEACHING AREA PER PERCOLATI R TE9o. SQ.FT.
.7.�_WATER ENCOUNTERED
NUMBER OF LEACHING PITS
APPROVED . .. _ . . . . BOARD OF HEALTH ���4C`�`?" �����` /uU '!'��"�✓/UU
DATE . . . . . . . . . .
AGENT OR INSPECTOR
1"A OF Af4
S'r
THOMAS
E.
�.�7.�1��, �� r�r•�,�. o KELLEY
�yJ THOMAS E.KELLEY CO: No 24760 y
Y!/� F,NGINEERS—SURVEYORS
346 LONG POND DRIVE
PETITIONER SOUTH YARMOUTH,MASS. s�ONAt F
T.O.F. EL.= 46.7'± FINISH GRADE OVER D-BOX = 38•8'± 4"SCHEDULE 40 PVC MIN. SLOPE 1 % FINISHED GRADE OVER BIODIFFUSERS 38,3' - 38.7' GENERAL NOTES
f PROVIDE H.D.P.E. RISER SLOPE @ 2% MIN.
w/COVER TO WITHIN 6" REMOVABLE WATER-TIGHT COVER OVER INSPECTION PORT WITH 1. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION
FINISH GRADE OF F.G. (TYP OF 2) RISER TO WITHIN 6"OF FINISHED GRADE ACCESS BOX TO WITHIN 3"OF METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL
@ FND. EL.= 40.0'± F.G. OVER TANK EL. = 39,6'± 5" DIA. OUTLET(S) F.G. (ONE PER OUTER ROW) CODE AND ANY APPLICABLE LOCAL RULES.
20"MIN.ACCESS � DESIGN ENGINEER.
EXISTING 4" " 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE
COVER(TYP.OF 3)�
PROPOSED 4" 9 MIN. 9 MIN.
---------- -- PVC SEWER PIPE 36"MAX. ! 36" MAX. TOP OF SAS/B.O. = 37,49' 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL
SEWER PIPE F
" 3"DROP MAX � SYSTEM UNLESS OTHERWISE NOTED.
6' 3 " _ PROVIDE WATERTIGHT 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN
2" DROP MIN 3 9 L 26±
MIN.SLOPE Q 1% JOINTS (TYP.)
„ ELEVATION =37.49' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS A
10" 4" PVC IN FROM i 1•pg� 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF
14" �_ SEPTIC TANK 4" PVC OUT TO (TYP ) 13 THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION.
• LEACHING FACILITY 0.59' 7.13"(TYP)
t 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM.
CONTRACTOR CONTRACTOR SHALL ' 12" 6"
SHALL VERIFY SIZE 48" VERIFY CONDITION OF OUTLET TEE 37.27 MIN. 37.1 O 37.001. 36.41 (laid flat) 2.875'(34.5")--I 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL.
AND CONDITION OF EXISTING TEES GAS BAFFLE 5.0' (TYP.) 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK
EXISTING SEPTIC AND REPLACE AS ?4W 6"CRUSHED STONE (TYP.) 5'MIN. FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS
REQ'D
TANK NECESSARY OVER MECHANICALLY 14.375'
COMPACTED BASE NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH
20.0' AND DESIGN ENGINEER.
5 OUTLET DISTRIBUTION BOX (TYP.)
- - - TO BE INSTALLED ON A LEVEL STABLE � 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM. ELEVATION OF 40.00'
GROUND WATER ELEV.= 31.33 BIODIFFUSERS END VIEW ESTABLISHED ON A CORNER OF THE CONCRETE PAD, AS SHOWN ON PLAN.
BASE. FIRST TWO FEET OF OUTLET ( )
EXISTING 1 ,000 GALLON CONCRETE SEPTIC TANK PIPES TO BE LAID LEVEL. BIODIFFUSERS PROFILE 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION
(PROFILE) THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT
CROSS SECTION VIEW (BY INFILTRATOR SYSTEMS, INC.) 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES
"CONTRACTOR TO VERIFY EXISTING ELEVATION PRIOR
SEPTIC TANK PROFILE DISTRIBUTION BOX DETAIL ARC 36 (#3613BD) BIODIFFUSERS TO THE DESIGN ENGINEER.TO ANY WORK & NOTIFY ENGINEER IF DIFFERENT. NOT TO SCALE NOT TO SCALE NOT TO SCALE 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONCRETE
- - -- - ---
-- ----- - - - STRUCTURES SHALL BE MADE WA
sTEST PIT DATA 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING
PERC NO. 13663 REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM
' ? f 0 � INSPECTOR: Donald Desmarais, R.S. APPROPRIATE AUTHORITY.
i r� 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS
� OZONE � EVALUATOR: Michael Pimentel, E.I.T.
�
Oct. 1999 LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE c1 r C.S.E. APPROVAL DATE:DATE: June 8,2012 THEY SHALL WITHSTAND H-20 LOADING.
13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES.
TEST PIT#: 1
$a C7 ELEV TOP- 38.00' 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE
MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY.
ELEV WATER= 31.33' REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY,
FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3).
w- I PERC RATE _ <2 min./inch
*• �/ I 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN
R `#• #' DEPTH OF PERC= 24"-42" SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK.
« , • I �Q TEXTURAL CLASS: 1 16. PROPOSED PROJECT IS LOCATED WITHIN:
• ' .Y ASSESSOR'S MAP 292 PARCEL 236
PROPOSED INSPECTION PORT ✓ ,� « ) A 0" Loamy Sand 38.00' OWNER OF RECORD: NEILA M. DIAMANTINO
WITH ACCESS BOX (TYP OF 2) CV) • • 4" 37.6T
LOCI IS 10YR 311 ADDRESS: 26 MEGAN ROAD
C7 V
_ • � HYANNIS, MA 02601
PROPOSED TOTAL 20 ARC 36 (#3613BD) Loamy Sand
REMOVE & REPLACE TO"C-1"SOIL, „/ N � ,/ ,� � � B 10YR 516 FEMA FLOOD ZONE C
BIODIFFUSERS IN A FIELD CONFIGURATION r
IF NECESSARY(SEE NOTE 14) 24" 36.00' COMMUNITY PANEL# 250001 0005C
�f.. na ! I► Perc
S
' `� 78023145,,E MAP 292 ZONE 2 t �s 42" 34.50' 17. DEED REFERENCE: DEED BOOK 19950, PAGE 108
17
_ _ Coarse Sand
,..
�00
7\1
, PARCEL 235 ' Q C1 2.5Y 6/4 18. PLAN REFERENCE: P.B. 261, PG. 37
1 F` 5%-10% Gravel
G
R VEL y
Q o - 3� ,-- 72" 32.00' 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION.
w \
j -� i- �*AS
Mottlin 80"
O 80" 9 @- - 31.33' 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY
to Z W � Y) o ;�� ,. N,,,• .- 3y ` � �� FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY
- ,.. �-- BP FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE.
(� 2 CS
m 31
GAS PR. D-BOXY X37x5'`_v w. r� ' ' r �f} 1 _ �� 100" Standing G.W.@ 100" 29.67'
W #26 LSA
co
EXISTING r-_ o -r Medium Sand
3-BEDROOM ' r� O SHED C2 2.5Y6/6
�I J DWELLING 's: O LOCUS PLAN
al, G``ft-... TOF =46.7'± MAP 292
r x 120" 28.00'
O RAVEL DRIVE '� " i /TP 2 0� LSA PARCEL 70 SCALE: 1"= 1000'
p
p PAVED �
W DRIVE f b o -
_ LSE, _ DESIGN DATA TFST PIT DATA LEGEND
pry LSA / LSA V- Co
MAP 292 � PERC NO. 13663
INSPECTOR: Donald Desmarais, R.S.
PARCEL 236 -- 50 - - EXISTING CONTOUR
13,600 S.F.± NUMBER OF BEDROOMS (DESIGN) 3 EVALUATOR: Michael Pimentel, E.I.T. r vu PROPOSED CONTOUR
Benchmark _ C.S.E. APPROVAL DATE: Oct. 1999
Comer of Conic. Pad `FENCE TREELINE DESIGN FLOW 110 GAUDAY/BEDROOM DATE: June 8, 2012 GAS - EXISTING GAS LINE
Elev. =40.00' N78- TOTAL DESIGN FLOW 330 GAL/DAY TELf EXISTING TELEPHONE LINE
170.000.0p
Approx. M.S.L. EXISTING 1,000 GALLON , � MAP 292 660 TEST PIT#: 2
SEPTIC TANK TO BE / DESIGN FLOW X 200 % = GAUDAY ELEV TOP = 38.00' W W- EXISTING WATER LINE
UTILIZED IN THIS DESIGN PARCEL 69
_ USE EXISTING 1,000 GALLON SEPTIC TANK ELEV WATER- 31.33'
MAP 292 ❑/H/W EXISTING OVERHEAD UTILITIES
EXISTING LEACHING PIT TO BE PUMPED & PARCEL 237 PERC RATE _ TEST PIT LOCATION
REMOVED IN ACCORDANCE WITH 310 CMR 15.000 c
INSTALL 20 - ARC 36 (#3613BD) BIODIFFUSERS DEPTH OF PERC=
_ o Q EXISTING 1,000 GALLON SEPTIC TANK
TEXTURAL CLASS: 1
SWING-TIES SCALE: 1" -20' SYSTEM CAPACITY 0" 38.00' LP EXISTING LEACHING PIT
(TOTAL L.F. OF BIOS)(4.8 SF/LF)(0.74 GPD/SQ.FT.) =GPD A Loamy Sand
DESCRIPTION HC-1 HC-2 (100.0')(4.8 SF/LF)(0.74 GAUSQ.FT.)= 355.2 GAL. LEACHING/DAY 4„ 10YR 3/1 37.67' PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE
BIODIFFUSER CORNER(1) 30.3' 31.2' B Loamy Sand ®TOTALS: 1OYR 5/6 PROPOSED DISTRIBUTION BOX
BIODIFFUSER CORNER(2) 35.3' 29.5' TOTAL NUMBER OF BIODIFFUSERS: 20 24" 36.00'
® PROPOSED ARC 36 (#3613BD) BIODIFFUSER
BIODIFFUSER CORNER(3) 53.4' 49.4' TOTAL NUMBER OF COUPLINGS: 0
TOTAL LEACHING AREA: 480.0 Coarse Sand
BIODIFFUSER CORNER(4) 50.2' 50.5' TOTAL LEACHING CAPACITY: 355.2 C1 2.5Y 6/4 REV. DATE BY APP'D. DESCRIPTION
72"
5%-10%Gravel 32.00' PROPOSED SEPTIC SYSTEM UPGRADE
NOTE: 80„ Mottling a 80" _ 31.33' PREPARED FOR:
EFFECTIVE LEACHING AREA OF 4.80 SF/LF OBTAINED FROM THE CAPEWIDE ENTERPRISES
DEPARTMENT OF ENVIRONMENTAL PROTECTION APPROVAL LETTER
HC-2 (2 "MODIFIED APPROVAL FOR GENERAL USE" ISSUED TO INFILTRATOR ( Standing G.W. 100"
20.0 )3 SYSTEMS, INC., DATE OF ISSUANCE OCTOBER 3, 2003 (LAST MODIFIED 100" - .- 29.67' LOCATED AT
Medium Sand
#26 = 29.3' � MARCH 14, 2012). TRANSMITTAL NUMBER=X235253. C2 2.5Y 6!6 26 MEGAN ROAD
EXISTING W IT 14.3 HYANNIS, MA 02601
o (1 IT 0
DWELLING
W3-BEDROOM O SHED 120" 28.00'
SCALE: 1 INCH = 20 FT. DATE: JUNE 15, 2012
NOTES: TOF =46.7'± HG-1
4) of
0 10 20 40 80 FEET
�sw a,as,
1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE OF EACH SEPTIC W JOHN L. PREPARED BY:
SYSTEM COMPONENT. p RESERVED FOR BOARD OF HEALTH USE CHURCCIHILL JR. JC ENGINEERING, INC.
2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOCATION OF THE PROPOSED 0. 1807 2854 CRANBERRY HIGHWAY
LEACHING FACILITY TO ENSURE CONSISTENCY WITH TEST PIT DATA SHOWN ON THIS PLAN. ��TF EAST WAREHAM, MA 02538
REPORT TO ENGINEER AND LOCAL BOARD OF HEALTH IF SOILS ARE NOT CONSISTENT WITH SITE PLAN 508.273.0377
TEST PIT DATA.
I SCALE: 1" =20' Drawn By: BSM Designed By:MCP Checked By: JLC JOB No.2232
ACCESS COVERS MUST BE Wl THIN
9 MINIMUM. INVERT6" OF FINISH GRADE EL E VA T l ONS : DES l GN CR l TER l A . GENERAL NO TES :
3' MAXIMUM COVER INVERT OUT SEPTIC TANK: 37.8
FIRST 2' TO DESIGN FLOW:
BE LEVEL MIN 2" OF PEASTONE INVERT IN DIST. BOX: 37.6 3 BEDROOMS AT /10 G.P.D. PER I. THIS PLAN IS FOR THE DESIGN AND CONSTRUCTION
39.0 OR F I L TER FABRIC INVERT OUT D I S T. BOX: 37.43 BEDROOM EQUALS 330 G.P.D. OF THE SEWAGE DISPOSAL SYSTEM ONLY.
4' DIAM PIPE 38.2 3/4" - 1 I/2" DIA. INVERT IN LEACH CHAMBER: 37.4
�_ 37,8 37.43 IZ" %' DOUBLE WASHED STONE BOTTOM OF LEACH CHAMBER: 36.4 NO GARBAGE GRINDER 2. VERTICAL DATUM IS ASSUMED. FOR BENCH MARKS
'AfFLE� 37.6 1X II 37.4 °0 36.4 ADJUSTED GROUND WATER: 31.4 SET. SEE S1 TE PLAN.
OBSERVED GROUND WATER: 30.0 SEPTIC TANK REQUIRED:
3 OUTLET 6 LC-6 LEACHING CHAMBERS EXISTING D-BOX W14 STONE AROUND. 11 'r x 50'1 x 12'd BOTTOM OF TEST HOLE #1: 29.7 330 G.P.D. X 200x - 660 GAL. J. ALL CONSTRUCTION METHODS AND MATERIALS AND
1000 GAL H-20 SEPTIC TANK PROVIDED: 1000 GAL. EXISTING MAINTENANCE OF THE SEPTIC SYSTEM SHALL
INDEX WELL AlW 230. ZONED CONFORM TO MASS. D.E.P. TITLE 5 AND LOCAL
COMPACTED BASE
SEPTIC TANK CRUSHED STONE OR iJUNE 2016 READING-21.56'. ADJ-1.4- SOIL ABSORPTION SYSTEM REQUIRED: BOARD OF HEALTH REGULATIONS.
CO
ADJUSTED DESIGN PERC RATE � 5 MIN/1 NCH
N PROF l L E : NOT TO SCALE = GROUNDWATER. EL-31.4 SOIL TEXTURAL CLASS - 1 4. ALL SEPTIC SYSTEM COMPONENTS LOCATED UNDER
EFFL DENT L OAD I NG RA TE - 0.74 GPD/SF AREAS SUBJECT TO VEHICULAR TRAFFIC OR GREATER
- OBSERVED 330 GPD / 0.74 GPD/SF - 446 S.F. REQUIRED THAN 3' IN DEPTH SHALL BE CAPABLE OF W!TH-
GROUNDWATER. iL-JO.o STANDING H-20 WHEEL LOADS.
PROVIDED: 6 LC-6 LEACHING CHAMBERS
W/4' STONE AROUND, A-672 S.F. 5. ALL SEWER PIPE SHALL BE SCHEDULE 40 PVC OR
672" S.F. x 0.74 - 497 G.P.D. APPROVED EQUAL.
SOIL TEST PIT DA TA& 6. SEPTIC TANK AND D-BOX SHALL BE REINFORCED
AD I CA rE PRECAST CONCRETE OR APPROVED POLYETHYLENE,
1N0/CA TI IBSERVED BOTH SHALL BE WATERTIGHT. D-BOX SHALL BE WATER
PERCOLA ES TION _ OBSERVED
TEST - GROUNDWATER TESTED FOR LEVEL WHEN THERE IS MORE THAN ONE
TP .l P+15084 TP #2 OUTLET.
HORIZON TEXT HORIZON TEXTURE COLOR
o' TEXTURE COLOR- 39.0 0- 39.5 7. BEFORE CONSTRUCTION CALL "DIG-SAFE".
A LOAMY IOYR A LOAMY IOYR
SAND 3/6 SAND 3/6 1-888-D l G-SAFE AND THE LOCAL WATER DEPT.
12 - - - - - - - - - - - - - - - 38.0 12 - - - - - - - - - - - - - - - 38.5 FOR LOCATION OF UNDERGROUND UTILITIES.
B LOAMY IOYR B LOAMY IOYR
\ SAND 414 SAND 4/4
^ 26' - - - - - - - - - - - - - - - 36.8 24- - - - - - - - - - - - - - - - 37.5 8. SEPTIC SYSTEM INSTALLER SHALL NOTIFY THE
MED-COARSE IOYR MED-COARSE IOYR
Cl
SAND AND 616 C SAND AND 6/6 DESIGN ENG l NEER TWO DAYS PRIOR TO CONSTRUCTION
00 E 42' GRAVEL GRAVEL OF THE SYSTEM TO ALLOW FOR SCHEDULING OF THE
O CONSTRUCTION INSPECTIONS.
N _
OA* GRA v 9. EXISTING CESSPOOL TO BE PUMPED DRY AND
SOIL REMOVAL
toe 30.0 114 _ 30.0 BACKFILLED.
h • c TP SEE NOTE 10.
�G
l 12• 29.7 /2 29.4 10. ALL UNSUITABLE MATERIAL (A & B HORIZONS)
Q" -�
�_ ' DATE: JUKE 21. 2016 ENCOUNTERED BELOW THE INVERT OF 'THE LEACHING
/f r EXISTING ° TEST 8Y: 5TEPNEN NAAS FAC!L I TY TO BE REMOVED FOR A DISTANCE OF 5'
EXISTING `' 15 r.. LEACy SNEo WITNESSED BY: DAVID STANTON AROUND AND REPLACED WITH SAND IN ACCORDANCE
y pKECL/yG F/EGO PERC RATE_ l 2 MIN/INCH ,
�J ,fit
D-BOX
OVER
P4VED pR/VEjrAY l ' /� ;
BM.// CORNER IPATI
EL�40.0 E�ISTING 6 6 PRECAST CHAMBERS
TIC TANK 'N'/4" STONE AROUND / G,
LOT
13. 600 j .F. E
00
S'Nn
4 �)izl
S EP T l C SYSTEM DES / G /V
26 MEOAN ROAD , MAP 202 , PARCEL 206
l
BARNS TABLE . ( HYANNI S ) MA .
s PREPARED FOR :
ROUTE 28 L US LEGEND N E / L A p / , M A S T / N O
BF
qs e CB CONCRETE BOUND
Q ��9 -W WATER LINE SCALE l 20 ' SEPTEMBER 21 2016
N O HYDRANT
GAS LINE STEPHEN A . HAAS
OHW- OVER HEAD WIRES
# LIGHT POST ENGINEERING , INC
-E- `UNDERGROUND ELECTRIC LINE / 1 �+ P . O . B o x 16
-T- UNDERGROUND TELEPHONE LINE /� ���� S o u t h D e n n i s MA 02660
-CTV- UNDERGROUND CABLEVISION LINE ��ti \\ ( 508 ) 362-8 1 32
+40.4 SPOT ELEVATION
..---40------- EXISTING CONTOUR
LOCUS MAP 0 I 0 20 40 q p PROPOSED CONTOUR JOB NO: l 6-043